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�;;asa��?o City of Zephyrhilis Fire FaX-a�a-�so-oo2i
<br /> Permit Application
<br /> Date Received Phone Contact for Pertnit r � �' p�
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<br /> N .���� ` �� ` � Owner'syPhone Number � � ��
<br /> Owner's Name - '
<br /> Owner's Address 3�J'� L C� V� ��6 L 5 O� /�/ � 6 ' ���5
<br /> Fee Simple Titieholder Name Titfeholder Phone Number � � �
<br /> Fee Simple 7itleholder Address
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<br /> O 2 "� �N Lot#
<br /> Job Address c� O J �-L
<br /> Sub Division Parcel# � — -GG 1 - C.7 G�
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<br /> QBio-Hazard Waste Storage-ANNUAL a Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> aControlled Bum � Hood Installation
<br /> � Emergency Generetor<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generetor�30 kw � LPlNatura!Gas-ANNUAL Safe
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> � emi � ner
<br /> Spnnkler � �" ❑ G � Recreational Bum i /'r ��
<br /> � C �v��
<br /> Fire Alartn � ❑ � ❑ � � Sparklers !V
<br /> Hood Cleaning � u G ❑ � � Sprinkier System Instaflations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkier Sys}
<br /> � Fire Aiarm Installation � Torch Roofing/Tar Kettie
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> � Flammabfe Application-ANtJUAL Valuation of Project
<br /> Fuel Tanks
<br /> � Other:
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<br /> Contractor Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Gurrent Y/N
<br /> Address License#
<br /> OTHER � ' �� Company Y �L(��(Z =l2�� � f�c �rL CTZB/��
<br /> Signature ��JV`, Registered /N Fee Current Y/N
<br /> Address �1 - License# _
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<br /> Directions�
<br /> Fill out application completely
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> 1{over$2500,a Notice of Commencement is rec}utred{Mechanicaf work over$5000)
<br /> Suoply two(2)sets of drawings with applicable documentation
<br /> Allow 1C-14 days ior r=view after submittaf date Parcel#-obtained irom Property Tax Notice(http:/lappreiser.pascogov.comj
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